MEDICARE: DR. D. PAUL RODRIGUEZ PH.D., LPC, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401002109	MI
2	101YP2500X	Professional Counselor	PMH 675	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MH9594	OTHER	FL	STATE OF FL

General Provider Information

NPI Number	:	1417063546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. D. PAUL RODRIGUEZ PH.D., LPC, LMHC

Provider Business Mailing Address
First Line	:	PO BOX 6728
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34290-6728
Country	:	US
Telephone Number	:	941-564-8734
Fax Number	:	941-876-3452

Provider Business Practice Location Address
First Line	:	2571 N TOLEDO BLADE BLVD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34289-9351
Country	:	US
Telephone Number	:	941-564-8734
Fax Number	:	941-876-3452

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	10/09/2023

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